How do I manage men who have used anabolic steroids?

Andrew Toogood

Anabolic agents are used to enhance performance through their effects on muscle mass, strength, and stamina. The prevalence of anabolic steroid use is difficult to quantify amongst the general population, but estimates derived from anonymous questionnaire studies in various populations suggest use may be common. Up to 4% of 18 years old American males have reported use at least once. Reported use of these agents rises significantly amongst army recruits and further still in elite athletes. Anabolic steroids are freely available from the internet and are used particularly amongst the gym population. Chronic use is associated with suppression of the hypothalamicpituitaryadrenal axis, sexual dysfunction, infertility, testicular atrophy, and gynaecomastia. Other adverse effects are focused on the cardiovascular system, are hepatotoxic and can psychological disturbance.

The patient presenting to the endocrine clinic is most likely to complain about infertility or sexual dysfunction. A full history with detailed drug history should be recorded and a full physical examination undertaken. Measurement of gonadotrophins, testosterone, and SHBG will confirm suppressed gonadotrophins in the context of a low testosterone. A full blood count and liver function and enzymes should also be taken as part of the assessment for complications. The mainstay of management is abstinence from anabolic steroids. It may take 12 months, but recovery of the hypothalamicpituitarygonadal axis should be complete. Occasional measurement of gonadotrophins and testosterone levels confirm recovery and abstinence. In some cases referral to addiction services may be required to provide support during withdrawal from anabolic steroids.